Infertility is the inability of a couple to conceive after one year of unprotected sexual intercourse. In fact for females above 35 years of age, the duration of unprotected sex for conception is 6 months only. This is because it is considered that female fertility declines with age.
What causes infertility?
Inability of a couple to conceive can be due to issues with either partner, or a combination of factors from both that interferes with pregnancy.2 Causes of infertility in men can vary from abnormal shape, number, motility, or delivery of sperms. The female reproductive system is even more complex and any uncharacteristic functioning of ovaries, fallopian tubes, or uterus can cause fertility issues.
How is infertility diagnosed?
Diagnosis starts with a thorough evaluation of the personal, medical, and sexual history of the couple. Females are also asked about their menstrual history. This is followed by a physical examination. Individual tests are then performed to find out the cause of infertility.
Diagnostic tests for males
- Semen analysis: Semen analysis is done to find out the sperm shape, sperm count, and sperm motility.
- Hormone test: The level of hormones such as testosterone is done through a blood test.
- Testicular biopsy: It is done to find out any abnormality in testes that may cause infertility.
- Imaging: Sometimes imaging tests like transrectal or scrotal ultrasound, brain MRI, bone mineral density scan, or vasography is done.
Diagnostic tests for females
After a pelvic examination, the doctor may prescribe the following tests to diagnose infertility in females:
- Ovulation test: Blood test is done to evaluate the level of hormones to confirm ovulation.
- Hysterosalpingography: It is a type of x-ray in which a contrast material is injected into the uterus to evaluate the condition or blockage of uterus and fallopian tubes.
- Hormone tests: These are done to check the levels of ovulatory and pituitary hormones that control the process of reproduction.
- Pelvic ultrasound: It is done to find out any disorders of the uterus and fallopian tubes.
Treatment for Infertility
Treatment for infertility involves education, medication, surgery, intrauterine insemination, or assisted reproductive techniques. The choice of treatment depends on factors such as cause of infertility, duration of infertility, and the couple’s age. To start with, the couple is thoroughly educated about a woman’s fertile period and how to maximise the chances of conception at this time. In addition they are guided to change their lifestyle and adopt healthy eating habits. If this fails, the following treatment options may be selected:
Treatment for males
- Medication: Doctor may prescribe medicines to increase testicular function, including sperm production and quality for better chances of pregnancy.
- Surgery: Some conditions may require surgical intervention – varicocele repair, reversal of sperm blockage etc. – to improve conception rates.
- Sperm retrieval: This technique is used to obtain sperm from semen for assisted reproductive techniques.
Treatment for females
- Medication: Fertility drugs are given to stimulate ovulation for pregnancy.
- Surgery: Surgery is sometimes required to treat problems such as endometrial polyps, uterine septum, or intrauterine scar tissue.
- Intrauterine insemination (IUI): This procedure involves direct placement of healthy sperm in the uterus around the time of ovulation for fertilisation.
Assisted reproductive technology (ART)
This treatment requires handling of egg as well as sperm for reproduction. IVF is the most common ART in which eggs are stimulated and retrieved from a woman, fertilised with male sperm in the lab, and then implanted in the uterus. Other techniques that may be used include intracytoplasmic sperm injection (ICSI), assisted hatching, donor eggs or sperm, or gestational carrier.
All these treatment options usually result in pregnancy. So infertility can be considered a curable condition in most cases.